Medical Billing Revenue Cycle
Resume:
MAGID MICHAEL DIMIAN
TARZANA CA 91356
OBJECTIVE Experienced PFS/Revenue Cycle leader seeking opportunities to improve financial performance and outcome for the health systems. Seeking to learn additional skills and business intelligence to deliver the desired financial targets and objectives
EXPERIENCE Extensive financial experience, payer contracts and negotiation delivering favorable financial outcomes
Kaiser Permanente
Not-for-Profit integrated health system with over $4 Billion receivable from FFS payers, teaching organization with own school of medicine and residency program. Over $12 Billion of annual gross charges (FFS payers) and $4 B collection
11/2012- Present
Regional Managing-Director: Patient Financial Services: CA Region 12/2016-Present
Oversee FPS operation for KP CA North and Southern Regions $84 B Net revenue
Direct accountability over FFS collection and Denial management, payment posting, EBOs, TPL.
Labor negotiation and keeping with union/business terms and contract guidance
Automation of the payment posting via AI/BOTS optimizing workflow, staff reallocation, accuracy/speed
Install of HiPass solution to enhance posting efficiency and cut cost (70% cost reduction)
Coordinating with Front/middle ends Revenue cycle leadership to align on KPI/goals and initiatives improving collection, AR aging and denial reduction
Direct reports: Over 147 staff, 1 Dir. 2 Sr. managers, Plus all EBOs operations (6 agencies)
2 RFPs to enhance collection activities and revenue KPIs
Partnering with physician champions to adopt finance performance initiatives to enhance performance and align with policies
Install Way-star in the NW region and CAL. Regions to vendor manage traffic control assignments to EBOs
Regional Director-Patient Financial Services: NW Region 11/2012-12/2016
Oversee PFS operation for Kaiser Permanente for the NW region (WA-OR) $3.2 B net revenue
Redesign KP existing Epic processes to optimize Epic inherit functionalities
Collaborate with Kaiser’s Revenue Cycle (7 regions Revenue Cycle directors) to align and improve KP-Enterprise performances and help established industry standards KPI
Engage new technologies, banking solutions to ensure integrated and cohesive systems communication and operations
Direct a team of leaders to maintain and surpass KP-NW annual revenue, budget, and PI initiatives
Coordinate with Labor leadership to accomplish the necessary changes to keep with market dynamics and business demands
Negotiate vendor contracts and monitor performance of external assigned portfolio
Install Epic billing module (Tapestry) 9/2015 with optimal success
Set department budgets to align with staffing, performance expectations and expansion/growth
Monitor and improve on department KPI, dashboards and matrixes to support a successful Revenue operation
UCLA HEALTH SYSTEM (2011-2012)
A not-for-profit academic and teaching facilities, trauma 1 center, over 1400 beds 3 hospital system
Assistant Director-Patient Business Services 7/2011-10/2012
Oversee backend of the revenue cycle operation-(PFS) for UCLA hospitals Ronald Regan-UCLA hospital, Santa Monica-UCLA hospital and the Resnick Neuropsychiatric Hospital. Manage daily operation for Billing, Collection, Denials, Transplant, Refund, Customer Service/Self pay, Payment Posting and vendor management for commercial and Government programs (143 employees, $ 1.8 B in net revenue reports to ED Rev. Cycle)
Ensure compliance with the new billing requirements under the 5010 standards (2012 install)
Chair monthly conferences with all major payers to ensure compliance with the contractual terms and government regulation, guidelines. Initiate legal action when necessary
Design a full Business Office Process flow for the health-system on Epic Install (2012).
Responsible for daily monitoring of UCLA’s KPI and dashboards with monthly reporting to the CFO and the UC governance body
Partnering with IT on technology delivery systems, updates, changes on boarding to deliver efficiencies and performances to the various segments of Rev. Cycle
CEDARS-SINAI MEDICAL CENTER (1989-2011)
A not-for-profit teaching facility, trauma 1, over 1200 beds hospital systems, UC campuses research and teaching affiliations, transplant programs, mature clinical trials operation
Health System Manager- PFS 2/2007-7/2011
Managed the daily operation of Patient Financial Services (PFS) Billing, Collection, Revenue Recovery, Denial Management, Refund, Cancer Center and Transplant billing and AR management (41 employees, $2.2B net revenue. $8 Billions gross charges).
Responsible for setting, ensuring, and delivering on CSMC business KPIs and the expectations for production and quality guidelines
Direct responsibility of coordinating all legal actions against payers violating contract terms of reimbursement, designated PMK on all cases in mediation and arbitration for Cedars-Sinai. Conduct and coordinate on behalf of CSMC with all retained law firms concerning filing strategies and settlement authority
Conduct and coordinate training sessions for different departments and revenue cycle stake holders, vendors on revenue cycle expectations and flow.
Worked closely with the management team for the hospital contracting department providing language recommendation to secure the health system financial rights and strengthen the hospital’s position should legal action is pursued
Design workflows, EMR Work Queues, job descriptions, training material
Selection of EBOs, training, oversight to ensure quality, performance, and deliverance on KPIs and financial objectives
Denial monitoring, data measure, consult with Registration and Coding leadership for proper ownership, action plans to correct and resolution. Owned communication with payers to facilitate solutions of underpayments, ultimately arbitration should need be to enforce contract terms
SOX policies and guidelines enforcement
Assisted in Epic design and install 2008. Epic top 3% performer club (AR management and denial prevention)
HFMA presentation (Denial management, scanning and Indexing and QW design and workflow)
Health System Sr. Supervisor (Revenue Management Unit)-PFS 5/2004-2/2007
Direct and full responsibility of supervising Denial Management and Revenue Recovery teams
Training, processes design, production and quality review assurance, coaching, hiring.
Engaging payers, attorneys and other internal departments ensuring compliance with contract terms
Revenue Management Analyst-PFS 2/2001-5/2004
Lead a group of auditors conducting contract audits on closed accounts, accomplishment includes breaking through the expected collection budget by 200% and 260% for the first and second year.
Direct negotiation with the various payers’ ensuring the proper enforcement of contract terms.
Monitor trends, prepare and present reports to Revenue Cycle leadership
Medicare/Medical billing and collection supervisor 3/1999-2/2001
Ensure accurate and timely billing and collection
Update and train staff on governmental regulation
Department of Imaging- Registration Supervisor 2/1989-3/1999
Scheduling, Registration, charge posting, coverage verification, charge master creation
Achievements
Voted employee of the year twice 1993 & 1994
Cedars Sinai - President Award for excellence 1997 for most creativity initiatives
Education
Bachelor of Science, Alexandria University -School of Mechanical Engineering (1984-1988)
Coding Certification, Learning Tree University (1996)
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